What is the treatment for psoriatic arthritis (PsA)?

From the Guidelines

Psoriatic arthritis treatment should start with nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or ibuprofen (400-800mg three times daily) for mild symptoms, and for moderate to severe disease, disease-modifying antirheumatic drugs (DMARDs) are recommended, with methotrexate (15-25mg once weekly) often used as first-line therapy, as supported by the 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis 1. The primary goal of treating patients with psoriatic arthritis is to maximize long-term health-related quality of life, through control of symptoms, prevention of structural damage, normalization of function, and social participation, with abrogation of inflammation, targeted at remission, being an important component to achieve these goals 1. Some key points to consider in the treatment of psoriatic arthritis include:

• The use of a treat-to-target strategy, which may involve regular monitoring of disease activity and adjustment of treatment as needed to achieve optimal control of both joint inflammation and skin symptoms 1.
• The consideration of biologics, such as TNF inhibitors (adalimumab 40mg every other week, etanercept 50mg weekly) or IL-17 inhibitors (secukinumab 150-300mg monthly), for patients with inadequate response to DMARDs or with severe disease 1.
• The importance of individualizing treatment based on disease severity, affected joints, skin involvement, and comorbidities, as well as considering patient preferences and values 1.
• The need for regular monitoring for medication side effects and disease progression, with adjustments made as needed to achieve optimal control of both joint inflammation and skin symptoms 1. In terms of specific treatment recommendations, the 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis provides conditional recommendations for the use of various medications, including NSAIDs, DMARDs, biologics, and oral small-molecule medications, based on the level of evidence and patient-specific factors 1. For example, in patients with active psoriatic arthritis and predominant enthesitis, the guideline recommends starting oral NSAIDs over an oral small-molecule medication (such as apremilast) 1. Overall, the treatment of psoriatic arthritis requires a comprehensive and individualized approach, taking into account the patient's specific disease characteristics, comorbidities, and preferences, as well as the latest evidence-based recommendations.

From the FDA Drug Label

1. 3 Psoriatic Arthritis Enbrel is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in adult patients with psoriatic arthritis (PsA). Enbrel can be used with or without methotrexate.

2. 3 Recommended Dosage in Adult Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis, and Plaque Psoriasis Enbrel is administered by subcutaneous injection (Table 1).

Table 1 Recommended Dosage for Adult Patients with RA, AS, PsA and PsO

Patient PopulationRecommended Dosage

Adult RA, AS, and PsA50 mg weekly

Treatment for Psoriatic Arthritis: Etanercept (SQ) is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in adult patients with psoriatic arthritis (PsA) 2.

• The recommended dosage for adult patients with PsA is 50 mg weekly, administered by subcutaneous injection.
• Etanercept can be used with or without methotrexate.

From the Research

Treatment Options for Psoriatic Arthritis

• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat psoriatic arthritis (PsA), with studies showing their efficacy in controlling joint inflammatory-related symptoms in the short-term 3.
• Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide, and ciclosporin are also used to treat PsA, with varying levels of evidence supporting their efficacy 4, 5.
• Biologics and targeted synthetic DMARDs have revolutionized the treatment of PsA, offering significantly better clinical and radiographic outcomes 6.

Specific Treatment Approaches

• NSAIDs such as nimesulide and celecoxib have been shown to be effective in controlling joint inflammatory-related symptoms in the short-term 3.
• DMARDs such as sulfasalazine and methotrexate may be effective in treating peripheral psoriatic arthropathy and skin disease, although evidence is limited 4, 5.
• Novel agents and immunomodulatory therapies are being developed and tested, offering new treatment options for PsA 6, 7.

Challenges and Unmet Needs

• Despite advances in treatment, there are still challenges and unmet needs in the management of PsA, including difficult-to-treat disease courses and lack of consensus on treatment withdrawal protocols 6.
• Further research is needed to better understand the efficacy of different treatment approaches and to develop more effective therapies for PsA 4, 5, 3, 7.